Beyond Sleep Hygiene: CBT Solutions to Improve Outcomes and Resolve Insomnia Symptoms in Clients with Anxiety, PTSD, Depression, and More

CPD

Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Handouts

Speaker

Donn Posner, PhD, DBSM Related seminars and products

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Donn Posner, PhD, DBSM, is the founder and president of Sleepwell Consultants and provides consultation to organizations and individuals on a wide variety of sleep health issues including insomnia, circadian dysrhythmia, CPAP adherence, and parasomnias. He is an adjunct clinical associate professor in the department of psychiatry and behavioral sciences at the Stanford University School of Medicine and a consulting psychologist for the Palo Alto VA. Dr. Posner works on a number of grants exploring the effects of CBT-I in Gulf War Veterans, and Veterans with insomnia and Mild Traumatic Brain Injury. He is also conducting a pilot aimed at using CBT-I techniques to decrease fatigue in breast cancer survivors by increasing total sleep time. Dr. Posner spent 25 years as the Director of Behavioral Sleep Medicine for the Sleep Disorders Center of Lifespan Hospitals and was a Clinical Associate Professor in the Department of Psychiatry and Human Behavior at the Warren Alpert School of Medicine at Brown University. He is a member of the American Academy of Sleep Medicine and is one of the first Certified Behavioral Sleep Medicine specialists recognized by that group. He is a founding member of the Society of Behavioral Sleep Medicine, and he has achieved the status of Diplomate of Behavioral Sleep Medicine (DBSM).

 

Speaker Disclosures:
Financial: Dr. Donn Posner is the founder and president of Sleepwell Consultants and has employment relationships with the Stanford University School of Medicine and the Palo Alto Veterans Institute for Research. He receives a consulting fee and serves as an advisory board member of NeuroUX, BrainTrain 2020 LTD, iSleep Clinic, and Z-Brain. He was a previous advisory board member for Dawn Health and Delta Sleep.io. Dr. Posner receives a speaking honorarium and recording royalties from PESI, Inc. All relevant financial relationships with ineligible organizations have been mitigated.
Non-financial: Dr. Donn Posner is a member of the American Academy of Sleep Medicine, the American Psychological Association, the Society of Behavioral Sleep Medicine, and the Association for Behavioral and Cognitive Therapies.

Objectives

1. Distinguish acute insomnia from chronic insomnia and identify treatment implications.
2. Conduct a thorough sleep assessment.
3. Analyze data from sleep diaries to inform treatment.
4. Employ stimulus control to strengthen the association between bed and sleep.
5. Conduct sleep restriction therapy to improve clients’ sleep drive.
6. Utilize cognitive strategies to reduce alarming sleep-related thoughts.

Outline

Sleep Disturbance Doesn’t Resolve on Its Own

Why Treating a Primary Mental Health Disorder Won’t Cure Insomnia

• Insomnia as a risk factor for behavioural health and medical disorders
• Treatment issues when insomnia is comorbid with depression, anxiety, and PTSD
• Sleep quality concerns with co-occurring chronic pain and illness
• What weakens sleep drive and disturbs circadian rhythms?
• Common thoughts and behaviours that contribute to sleep-interfering arousal
• How to teach clients about the 3 P’s - predisposing, precipitating, and perpetuating factors

Insomnia-Informed Assessment

How and What to Ask Your Clients

• Top questions for the initial interview
• Assessments for co-occurring sleep disorders
• Talking with clients about the impact of medications and drugs on sleep
• Evaluate sleep continuity, discern bad sleep habits, and identify daytime symptoms of insomnia
• Sleep diary and other take-home assessment resources
• How to get clear, useable information about your clients’ sleep patterns

Treatment Planning with Cognitive Behavioral Therapy for Insomnia (CBT-I)

Behavioural Strategies to Improve Sleep and Outcomes for Primary Mental Health Disorders

• Clinical practice guidelines and the state of research on insomnia treatment
• Who is a good candidate for CBT-I?
• Effective sleep hygiene for clients who haven’t addressed the basics
• Clock watching and its implications
• Sleep environment concerns
• Impact of eating, substances, and exercise
• Strengthen the sleep drive and circadian clock with sleep restriction therapy (SRT)
• Psychoeducation on rationale and addressing clients’ fears to increase engagement
• How to set the sleep window and when to extend time-in-bed
• Rules for before-bed activities and strategies for waking up on time
• Address conditioned arousal with Stimulus Control (SC)
  • Overcoming obstacles to strengthening the association between bed and sleep
  • Counter-arousal strategies
  • Activities your clients can use during periods of nighttime wakefulness

Cognitive Strategies to Help Clients Change Sleep-Interfering Thoughts & Beliefs

• Create a buffer zone and worry schedule for your clients
• Tools to identify thoughts and beliefs that perpetuate sleep problems
• Combat intrusive thoughts during sleep time
• Help clients reduce sleep effort and worry about lack of sleep
• Strategies to restructure expectations and thoughts
• Behavioural experiments to evaluate sleeprelated thinking

Clinical Considerations

Additional Factors for the Insomnia-Informed Clinician

• Best practices to address clients’ concerns about interventions
• Troubleshooting insufficient progress in CBT-I
• When to refer to a sleep specialist
• Limitations of the research and potential risks

Target Audience

• Counsellors
• Social Workers
• Psychologists
• Marriage & Family Therapists
• Physicians
• Addiction Counselors
• Case Managers
• Psychiatric Nurses
• Nurses
• Occupational Therapists
• Other Mental Health Professionals